Hi Howard, and Merry Christmas to you and the rest of the group,
Here is a statement I have pasted from marci-kids.com -
2. Sucralfate (Carafate)
This is an aluminum-containing, sticky sugar that binds to open, irritated
areas in the esophagus or stomach. The catch is that sucralfate requires
acid to become active. It also requires an irritated area. Because of
these
two factors and since it has to be given quite frequently (4-6 times/day),
it is not highly useful for the treatment of acid related disorders. Note
sucralfate should not be used with antacids or with H-2 blockers or with
PPI
drugs. This is because as was stated earlier, sucralfate requires an acid
environment to work.
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I understand that sucralfate forms a paste formed from gastric acid, that
binds to ulcer sites and creates a protective film, and that it works best
in an acid environment, preferably a pH below 4.0 (but I have also read in
one source that it may not require acid to work). The statement above
says
sucralfate should not be used with antacids or H2 blockers or PPI drugs.
The package insert for sucralfate references separating antacids (by 30
minutes), and H2's and other drugs by two hours (does not mention PPI's
which are about 10 times more effective at blocking acid than the H2
blockers).
If this is true (eg sucralfate should not be used with PPI drugs) then
would
you please explain why some gastroenterologists and surgeons (including
yourself) immediately prescribe BOTH nexium 40 mg bi-daily, AND sucralfate
four times a day (for
adults), when they find duodenal ulcers on endoscopic examination (kind of
like a double whammy, even though I understand the PPI's are the drugs of
choice and sucralfate is fading out). But if the high dose of nexium
raises
the pH significantly above 4 (which it will if it is working properly on
the
person taking it), than why would the gastro's or surgeon prescribe the
sucralfate in addition to the nexium, if it would just be blunted by the
nexium creating the higher pH and not allowing the acid paste to form.
Does
the sucralfate still have some capability of forming the paste and have
the
binding effect, even at a higher pH above 4 or 5. If not then what a
waste
of time and effort, especially since sucralfate is so hard to take with
it's
one hour before and two to three hours after restrictions on eating, and
don't take other pills within two hours of it to be safe, etc. It becomes
almost impossible to eat and take other pills if you take the sucralfate
four
times a day.
I would also like to know how sucralfate can bind to the esophagus if you
swallow the "pill form" with a glass of water and it immediately goes to
your gut (I believe the pills are way better than two teaspoons of the
suspension since the pill immediately dissolves in the water and IMO will
be
able to disperse better and form the paste in the stomach and duodenum).
The package inserts indicate the healing rates for duodenal ulcers are
much
higher for the pills than the suspension (at four weeks) and it also says
that equivalency of the suspension to the pill has not been demonstrated.
I
understand that swallowing two teaspoons of the suspension may cling to
the
esophagus briefly but I would think the effect would be negligible if you
had esophageal erosions. The drug is old and the data is old and calling
Axcan (the current pharma that owns it) is next to useless.
I would appreciate a response to my concerns. Thank you...Pete
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